The National Institute for Transforming India (NITI Aayog) provides critical knowledge, innovation and entrepreneurial support to the country. The NITI Aayog and the United Nations signed the Sustainable Development Framework (Government of India-UNSDF) for the year 2018-2022 in New Delhi on 28th Sep, 2018 in presence of 19 UN agencies. The Framework outlines the work of UN agencies in India to support the achievement of key development outcomes that are aligned to the national priorities. It marks a commitment towards attaining the Sustainable Development Goals (SDGs) and promotes “Sabka Saath Sabka Vikas”- development for all.[1]

According to the Human Development Report 2018, India ranks 130 in Human Development Index. The Human Development Index is a composite index measuring average achievement in three basic dimensions of human development-a long and healthy life (life expectancy at birth), knowledge (expected years of schooling and mean years of schooling) and a decent standard of living (Gross national income per capita).

BCG has been the only available vaccine against tuberculosis administered to neonates. It has beneficial effect in very young children but does not protect the adolescents and adults. A new vaccine for tuberculosis-M72/AS01E, developed by GlaxoSmithKline is the first vaccine to show more than 50% protection against development of TB infection in people. It is a subunit fusion protein vaccine derived from two M. Tuberculosis antigens (32A and 39A) with an adjuvant (AS01E) designed to provide protection against active TB.[2]

World Hepatitis Day was celebrated on 28th of July on the theme ‘Test. Treat. Hepatitis’. WHO has launched a new online Global reporting system for hepatitis (GRSH). The data is entered through a web-based District Health Information System (DHIS) module located on the WHO integrated data platform.[3]

Reports

World Health Organization (WHO) Malaria Report for the year 2018 was published in the month of November. A total of 219 million malaria cases were reported in 2017 with 4,35,000 malaria deaths. The overall incidence has remained stagnant for the past 3 years around 59 per 1000 population though it has declined by 18% globally between 2010 and 2017 (72 to 59 cases per 1000 population at risk). Fifteen countries in sub-Saharan Africa and India carried almost 80% of the global malaria burden. Furthermore, the percentage of the population with access to an Insecticidal Treated Net (ITN) increased from 33% in 2010 to 56% in 2017, which was a marginal increase since 2016. In India, the coverage is less than 50%. The percentage of households with at least one ITN for every two people doubled to 40% between 2010 and 2017. The WHO South-East Asia Region continued to see its incidence rate fall from 17 cases of the disease per 1000 population at risk in 2010 to 7 in 2017 (59% fall). Paraguay was certified by WHO as malaria free in 2018 while Algeria, Argentina and Uzbekistan have made formal requests to WHO for certification. In 2017, China and El Salvador reported zero indigenous cases. To get the global malaria response back on track, a new country-driven approach - “High burden to high impact” has been launched with four key elements: - political will to reduce malaria deaths, strategic information to drive impact, better guidance, policies and strategies, and a coordinated national malaria response.[4]

A first-of-its-kind single dose Malaria drug-Tafenoquine (Krintafel), has been approved by FDA in over 60 years for the “radical cure” of Plasmodium Vivax malaria in patients aged >16 years. In an RCT that compared Chloroquine plus either Tafenoquine or Primaquine, the relapse-free efficacy rate at 6 months was similar- 67% with Tafenoquine v/s 72.8% with Primaquine. Tafenoquine is an 8-aminoquinoline derivative with activity against all stages of the Plasmodium vivax parasite lifecycle including hypnozoites, with a single dose of 300 mg. However, this medicine is contraindicated in G6PD deficient individuals.[5]

There was an Ebola outbreak in the Democratic Republic of Congo (DRC) and it has been confirmed that the new Ebola outbreak is caused by the Zaire ebolavirus species. Health authorities in DRC have been instructed to use the ZEBOV vaccine. As of 14 December, 529 total cases (481 confirmed and 48 probable), including 311 deaths have been reported.[6]

Measles cases hit a record high in the European region. As high as 41,000 measles cases were reported in the WHO European Region in the first half of the year 2018. The highest annual number of measles cases between 2010 and 2017 was 23,927 for 2017, and the lowest was 5273 for 2016. Monthly country reports indicate at least 37 deaths due to measles. Serbia reported the highest number of 14 deaths. Ukraine saw the highest number of cases with over 23,000 people affected which accounts for over 50% of the Regional total.[7] On the other hand, nine countries were announced Measles free: Australia, Brunei Darussalam, Cambodia, Hong Kong SAR(China), New Zealand, Japan, The Republic of Korea and Singapore. Among these, five countries have also stopped transmission of Rubella: Australia, Brunei Darussalam, Hong Kong SAR(China), New Zealand, The Republic of Korea.[8] Intensified efforts towards immunization, disease surveillance and adoption of a regional strategy and plan of action led to this achievement.

National

Events

Since 1988 WHO has recommended that TT should be replaced by Td vaccine. National Technical Advisory Group of India (NTAGI), MoHFW has also recommended the replacement in India’s immunization programme for all age groups including pregnant women. It is a combination vaccine of Tetanus and Diphtheria with lower concentration of Diphtheria antigen (d) as recommended for older children and adult. WHO and UNICEF highlight that replacement of TT with Td vaccine will boost the waning diphtheria immunity in addition to assuring tetanus protection.[9]

India got its first Quadrivalent Influenza Vaccine-FluQuadri®. It is India’s first four-strain Influenza Vaccine for population aged above 3 years. It is manufactured in Swiftwater, USA. Sanofi Pasteur launched the FluQuadri in India on 23rd July. Currently majority of seasonal influenza vaccines are trivalent (two A strain and one B strain Victoria/Yamagata). Both B lineages have been consistently observed. It is a single dose vaccine with dose of 0.5 ml for adults and children above 3 years given intra-muscularly in the upper arm.[10]

Health Ministry issued a notification for bringing the HIV/AIDS Act 2017 into force from 10th September, 2018. The HIV and AIDS Prevention & Control Act 2017 safeguards the rights of people living with HIV (PLHIV) and affected by AIDS. It seeks to prevent and control the spread of HIV & AIDS, prohibits discrimination against PLHIV /AIDS. Court of a Judicial MagistrateFirst Class shall take cognizance of an offence under this Act. Penalty for contravention is imprisonment for 3 months to 2 years and with fine upto Rs. 1 lakh, or both.[11]

September was celebrated as Rashtriya Poshan Maah (National Nutrition Month). It marked the country’s fight against malnutrition. Aim was to reach every household with message of nutrition- ‘Har ghar poshan tyohar’ (every house a celebration of nutrition). The target was to bring down stunting among children up to the age of 6 years from 38.4% (as per NFHS-4) to 25% by 2022.[12]

The Cabinet approved ASHA Benefit package w.e.f. 1st October with 2 components: ASHA and ASHA facilitators will be enrolled in social security schemes namely Pradhan Mantri Jeevan Jyoti Bima Yojana and Pradhan Mantri Suraksha Bima Yojana and an increase in routine incentives from Rs. 1000 per month to Rs. 2000/month. This is in addition to other task-based incentives approved at Central/State level. The Estimated beneficiaries are 10,22,265. Cabinet also approved an increase in the honorarium of AWW/AWH from Rs. 3,000 to 4,500 and Rs. 1,500 to 2,250 respectively.[13]

Guidelines

National Viral Hepatitis Control Program was released with a set of guidelines which are Operational Guidelines for National Viral Hepatitis Control Program, National Laboratory Guidelines for Viral Hepatitis Testing and National Guidelines for Diagnosis and Management of Viral Hepatitis and offering free drugs and diagnostics for hepatitis B & C. This initiative will provide laboratory testing and management of viral hepatitis with a decentralized approach. The goal of the program is to end viral hepatitis as a public health threat by 2030 in the country. The key strategies are: preventive and promotive interventions; awareness generation; safe injection practices and socio-cultural practices; sanitation and hygiene; safe drinking water supply; infection control and immunization; co-ordination and collaboration with different Ministries and departments; increasing access to testing and management of viral hepatitis; promoting diagnosis and providing treatment support; capacity building at national, state, district levels and sub-district level up to Primary Health Centres (PHC) and Health and Wellness Centres (HWC).[14]

Schemes

Ayushman Bharat scheme was launched on 25th September with aim to cover over 10 crore poor vulnerable families (over 50 crore beneficiaries). Coverage of up to Rs. 5 lakh per family per year which has a positive impact on reducing out-of-pocket expenditure. An Empanelled Health Care Provider known as Arogya Mitra will be employed to provide support to the beneficiaries for the scheme.[15]

Regional

Events

WHO has appreciated Odisha for rapid reduction of malaria cases and has marked the state as a role model. There were 56 reported deaths in the period of July-Dec in 2016 which fell by more than two thirds to 16 in 2017 with an 85% reduction in deaths. It accounts for 40% reduction of total cases in India. The state attributes to IEC activities and Durgama Anchalare Malaria Nirakaran (DAMAN) scheme implemented in Dec 2016.[17] A month-long programme, Anemia Mukt Bharat/Odisha-a ‘Test & Treat’ campaign focussed on women of Reproductive age (15-49 years) and under-5 children was launched in collaboration with State National Health Mission and UNICEF as a part of ‘Poshan Maah’. AIIMS New Delhi was the Nodal Centre along with six peripheral AIIMS conducting the ‘Test and Treat Anemia’ campaign. People identified to be mild/moderate anemic were provided oral IFA supplementation and counselling and those found to be severely anemic were referred for management at higher centres. The strategy focussed on testing & treatment of anemia in school going adolescents & pregnant women using newer technologies like Haemocue 301, establishing institutional mechanisms for advanced research in anemia and a comprehensive communication strategy including mass/media communication material. A web-portal-anemiamuktbharat.info has been developed as part of the monitoring mechanism of the strategy. It will provide survey data on anemia across beneficiary groups, target prevalence of anemia as per POSHAN Abhiyan and quarterly HMIS based reporting of programme implementation coverage up to the district level.[17][18]